Factors Associated With the Cost of Care for the Most Common Atraumatic Painful Upper Extremity Conditions

Journal of Patient Experience

et al. 2021

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Health organizations want to measure patient-reported outcome measures (PROMs) longitudinally. Two medical assistants called people selectively at 6 weeks and routinely at 6 months to obtain PROMs as part of routine musculoskeletal specialty care. Only 47% of patients (123 of 263) were reached by phone at 6 weeks and 41% (246 of 594) at 6 months. Spanish speakers were more likely to answer. Eighty-nine percent of people reached at 6 weeks and 76% reached at 6 months were willing to complete PROMs. Speaking Spanish, older age, and fewer symptoms of depression were associated with completing PROMs when reached by phone at 6 weeks. Women and Spanish-speaking patients were more likely to participate at 6 months. The observation that most people do not participate in longitudinal PROM measurement in a system that devotes notable resources in the setting of musculoskeletal specialty care—with some variation by psychosocial factors—suggests that longitudinal PROM measurement may be infeasible. Future work can explore alternative measures of the value of care that account for the large percentage of people that deprioritize care after a single specialty visit.

Section: Discussionmentioning

confidence: 99%

Check-in Phone Calls Six Weeks and Six Months After Musculoskeletal Specialty Care

Mercado

Gonzalez

Journal of Patient Experience

et al. 2021

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“…Those of us who see a specialist are usually satisfied with a single visit. 13 In other words, accommodation is an effective and highly utilised health strategy. The key aspects of accommodation may be healthy mindsets and healthy circumstances (security in employment, finances, home, food, relationships and roles).…”

Section: The Health Benefits Of Accommodationmentioning

confidence: 99%

Mindsets matter for every patient and we can all help

2023

BJPsych open

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Summary People seek care when a sensation becomes a symptom (a concern). Levels of discomfort and incapability are associated with feelings of distress or unhealthy misinterpretation. To limit mental health stigma, it is important to emphasise that this is about how the human mind works (mindsets) and not just about mental illness. Experts in mental health and in pathophysiology can work together, each doing their part to optimise mindset.

“…1 2 3 Overuse is defined as “a healthcare service that is provided under circumstances in which its potential for harm exceeds possible benefit.” 4 Despite these concerns, utilization increased by about 10% annually between 1996 and 2010. 5 Medicare alone spends approximately 2.9 billion dollars annually on MRI and CT. 6 Advanced imaging modalities are costly, 7 8 and may lead to iatrogenic harm, increased symptoms of anxiety, 9 and undue exposure to radiation. 10 Imaging appropriateness guidelines can standardize the use of imaging based on scientific evidence and may prevent the use of unhelpful imaging.…”

Section: Introductionmentioning

confidence: 99%

Upper Extremity Surgeon Recommendations for Imaging Do Not Correspond with Imaging Appropriateness Guidelines

Ramachandran

Journal of Hand and Microsurgery

Crijns

2024

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Background Utilization of magnetic resonance imaging (MRI) and computed tomography (CT) increases annually, raising concerns about overuse. Imaging appropriateness guidelines have the potential to standardize decisions regarding imaging based on best evidence, which might reduce unhelpful or potentially misleading imaging. We studied expert use of advanced imaging for musculoskeletal illness compared to published appropriateness recommendations. Methods First, 15 imaging guidelines with recommendations for advanced imaging of the upper extremity were collated. Next, members of the Science of Variation Group (SOVG) were invited to participate in a survey of 11 patient scenarios of common upper extremity illnesses and asked whether they would recommend MRI or CT. Guideline recommendations for imaging were compared with surgeon recommendations using Fisher's exact tests. We used Fleiss' kappa to measure the interobserver agreement among surgeons. Results For the 11 scenarios, most imaging appropriateness guidelines suggested that MRI or CT is useful, while most surgeons (n = 108) felt it was not. There was no correlation between surgeons and guidelines recommendations for imaging (ρ = 0.28; p = 0.40). There was slight agreement among surgeons regarding imaging recommendations (kappa: 0.17; 95% confidence interval: 0.023–0.32). Conclusion The available imaging appropriateness guidelines appear to be too permissive and therefore seem to have limited clinical utility for upper extremity surgeons. The notable surgeon-to-surgeon variation (unreliability) in recommendations for advanced imaging in this and other studies suggests a role for strategies to ensure that patient decisions about imaging are consistent with their values (what matters most to them) and not unduly influenced by patient misconceptions about imaging or by surgeon beliefs and habits. Level Of Evidence II, diagnostic